The objective of this study was to investigate the prevalence of depression and anxiety among patients with chronic hepatitis C and how depression and anxiety correlate with respective health-related quality of life (HRQoL) domains, sociodemographic factors, and clinico-epidemiological characteristics. This prospective study involved 150 patients with chronic hepatitis C awaiting interferon treatment for hepatitis C and 150 healthy subjects. All individuals enrolled in the study completed the Short Form 36 (SF-36) questionnaire and Hospital Anxiety Depression Scale. The symptoms showed greater severity/score among patients with chronic hepatitis C for both depression (t=3.37; p<0.01) and anxiety (t=2.35; p<0.05). Regression analysis was used for estimating the relationship between depression and the set of predictors (domains of the SF-36 questionnaire). Three HRQoL domains (Physical Functioning, Vitality, and Mental Health) were found to have the strongest predictive contribution to the occurrence of depression. A series of Kruskal-Wallis and Mann- Whitney tests showed a significant difference in depression level between marital status categories (χ2(2)=7.86, p<0.05). Divorced participants had significantly higher scores compared to married participants (Z=-2.40, p<0.05) and single participants (Z=-2.75, p<0.01). Unemployment was associated with a higher degree of depression and anxiety. There was no association identified between duration of the disease, route of hepatitis C virus transmission, existence of cirrhosis, and depression or anxiety. The findings of this study can assist in developing a standard protocol for the management of chronic hepatitis C that will include psychological assessment and support.

Reveals that the human immunodeficiency virus (HIV) epidemic trends in Uzbekistan prove similar to those in most countries in the Commonwealth of Independent States, with early years of concentration among people who inject drugs (PWID) giving way (since 2010) to sexual transmission as the predominant transmission mode. The Uzbekistan HIV epidemic also includes nosocomial HIV transmission (transmissions occurring in hospital settings), which particularly affects children. The proportion of people on antiretroviral treatment (ART) has proven too small to have a significant preventive effect. The HIV epidemic indicators, service coverage, and modeling forecast show that overall the HIV response remains underfunded to an extent that precludes meeting the effort's stated objectives and fulfilling the commitments for universal coverage of essential HIV services. The Ministry of Finance has developed a plan to guide the transition from donor funding to full state funding of HIV programs, using the United Nations Development Programme (UNDP) to help develop this plan.

Reports that the human immunodeficiency virus (HIV) epidemic in Tajikistan remains concentrated among key populations. The country has seen a shift in the two main modes of HIV transmission. Since 2011, sexual transmission has dominated, and HIV prevalence among people who inject drugs (PWID) has remained high. Mother-to-child transmission, which made up only 0.4 percent of the new HIV infections in 2006, increased to 5.7 percent in 2014, and subsequently dropped to 4.9 percent in 2016. In recent years, men have accounted for approximately 60 percent of all newly diagnosed HIV infections. In the 15–29 age group; however, women account for most newly diagnosed cases. Analysis indicates that a rights-based approach, including "test and treat" and focusing on key populations, would avert the greatest number of deaths and new infections. It remains crucial for the government to seek opportunities for partial funding of key HIV program interventions from domestic resources.

Scientific contribution in high-impact journals is largely from authors affiliated with institutions in high-income countries (HICs). Publication of papers by contribution of individual countries to leading journals can provide a picture of the most influential countries in a particular discipline. The aim of the study was to identify changes in the patterns in authorship and origin of original research articles in relation to countries' income level in the field of public health in 2016 in comparison to previous studies. A descriptive analysis was conducted based on articles published in highly ranked public health journals in 2016. Based on the inclusion criteria, 368 research articles were identified. Over 80% of these studies were conducted in HICs. Authors were mainly based in HICs (84%), especially in the USA. The majority of first, last, and corresponding authors were affiliated with HICs (over 90%). Our study might serve as a prompt for editorial and advisory boards of the leading international journals to provide more opportunities for researchers based in low and middle-income countries.

Kielmann, K; Vidal, N; Riekstina, V; Krutikov, M; van der Werf, MJ; Biraua, E; Duric, P; Moore, DAJ; (2018) "Treatment is of primary importance, and social assistance is secondary": A qualitative study on the organisation of tuberculosis (TB) care and patients’ experience of starting and staying on TB treatment in Riga, Latvia. PloS one, 13 (10). e0203937. ISSN 1932-6203 DOI: https://doi.org/10.1371/journal.pone.0203937 Downloaded from: http://researchonline.lshtm.ac.uk/4649777/ DOI: https://doi.org/10.1371/journal.pone.0203937

Tuberculosis is one of the greatest global health concerns and disease management is challenging particularly in low- and middle-income countries. Despite improvements in addressing this epidemic in Georgia, tuberculosis remains a significant public health concern due to sub-optimal patient management. Low remuneration for specialists, limited private-sector interest in provision of infectious disease care and incomplete integration in primary care are at the core of this problem. This protocol sets out the methods of a two-arm cluster randomized control trial which aims to generate evidence on the effectiveness of a performance-based financing and integrated care intervention on tuberculosis loss to follow-up and treatment adherence. The trial will be implemented in health facilities (clusters) under-performing in tuberculosis management. Eligible and consenting facilities will be randomly assigned to either intervention or control (standard care). Health providers within intervention sites will form a case management team and be trained in the delivery of integrated tuberculosis care; performance-related payments based on monthly records of patients adhering to treatment and quality of care assessments will be disbursed to health providers in these facilities. The primary outcomes include loss to follow-up among adult pulmonary drug-sensitive and drug-resistant tuberculosis patients. Secondary outcomes are adherence to treatment among drug-sensitive and drug-resistant tuberculosis patients and treatment success among drug-sensitive tuberculosis patients. Data on socio-demographic characteristics, tuberculosis diagnosis and treatment regimen will also be collected. The required sample size to detect a 6% reduction in loss to follow-up among drug-sensitive tuberculosis patients and a 20% reduction in loss to follow-up among drug-resistant tuberculosis patients is 948 and 136 patients, respectively. The trial contributes to a limited body of rigorous evidence and literature on the effectiveness of supply-side performance-based financing interventions on tuberculosis patient outcomes. Realist and health economic evaluations will be conducted in parallel with the trial, and associated composite findings will serve as a resource for the Georgian and wider regional Ministries of Health in relation to future tuberculosis and wider health policies. The trial and complementing evaluations are part of Results4TB, a multidisciplinary collaboration engaging researchers and Georgian policy and practice stakeholders in the design and evaluation of a context-sensitive tuberculosis management intervention. ISRCTN, ISRCTN14667607 . Registered on 14 January 2019.

BACKGROUND:The leading cause of nonfatal injuries in age group 14-19 is sports injuries. Purpose of the study was to determine the association between intense physical activity and injury and to identify the circumstances and environment in which injuries are most likely to occur. METHODS:A prospective cohort study included 698 high school students 15-19 years old, divided into those exposed and those unexposed to intense physical activity. The international standard questionnaire about physical activity (International Physical Activity Questionnaire-IPAQ) and the metabolic equivalent task (MET) scores were used. RESULTS:The risk of injuries was 7 times higher (relative risk [RR]: 7.041; 95% confidence interval [CI]: 6.071, 8.187) and the risk of injuries requiring treatment in health facilities was 15 times higher (RR: 14.717; 95% CI: 10.652, 20.592) in the intensely physically active adolescents. The risk of gaining sports injuries was 11 times higher in the exposed group (RR: 11.212; 95% CI: 9.013, 14.074), with a significantly higher incidence rate (Inc.) among men (82.9 per 100). Most injuries occurred in football (Inc. 4.4 per 1000 hours), volleyball (Inc. 3.9 per 1000 hours), and boxing/kickboxing (Inc. 3.7 per 1000 hours). CONCLUSIONS:Intensely physically active high school students have a much higher risk of injury, which usually occurs during training or a match.

Background Tanzania remains among the countries with the highest burden of infectious diseases (notably HIV, Malaria and Tuberculosis) during pregnancy. In response, the country adopted World Health Organization’s (WHO) latest antenatal care (ANC) guidelines which recommend comprehensive services including diagnostic screening and treatment for pregnant women during antenatal. However, as Tanzania makes efforts to scale up these services under the existing health system resources, it is crucial to understand its capacity to deliver these services in an integrated fashion. Using the WHO’s service availability and readiness assessment(SARA) framework, this study assesses the capacity of the Tanzanian Health System to provide integrated Malaria, Tuberculosis and HIV services. Methods Composite indicators of the five components of integration were constructed from primary datasets of the Tanzanian Service Provision Assessments (SPA) under the Demographic and Health Survey (DHS) programs. Chi-squared analysis was conducted to determine the associations of each of the defined components and background characteristics of facilities/health workers. A logistic regression model was further used to explore strength of relationships between availability of service readiness components and a pregnant women’s receipt of HIV, Malaria and TB services by reporting adjusted odds ratios. Results Generally, capacity to integrate malaria services was significantly higher (72.3 95% CI 70.3–74.4 p = 0.02 ) compared to Tuberculosis (48.9 95% CI 48.4–50.7) and HIV (54.8 95% CI 53.1–56.9) services. Diagnostic capacity was generally higher than treatment commodities. Regarding the components of SARA integration, logistic regression found that the adjusted odds ratio of having all five components of integration and receiving integrated care was 1.9 (95% CI 0.8–2.7). Among these components, the strongest determinant (predictor) to pregnant women’s receipt of integrated care was having trained staff on site (AOR 2.6 95% CI 0.6–4.5). Conclusion Toward a successful integration of these services under the new WHO guidelines in Tanzania, efforts should be channelled into strengthening infectious disease care especially HIV and TB. Channelling investments into training of health workers (the strongest determinant to integrated care) is likely to result in positive outcomes for the pregnant woman and unborn child.

Background: Globally, an estimated 257 million people are living with chronic hepatitis B (HBV) infection and an estimated 71 million people with the chronic hepatitis C virus (HCV). The true public health dimensions and impact of hepatitis epidemics are poorly understood. Case definitions are fundamental parts of disease surveillance, representing sets of standardised criteria used to assess whether or not a person has a certain disease. The study evaluated the sensitivity and specificity of hepatitis B and hepatitis C case definitions, current at the time of data collection, recommended by the European Commission (EC) and the Centers for Disease Prevention and Control (CDC). Methods: The study involved 150 hospital referrals with suspected cases of hepatitis from a Serbian clinic during 2014/2015. Case definitions of hepatitis B and C were tested for their sensitivity, specificity, positive and negative predictive values. Results: EC 2008 and the CDC 2012 case definitions for acute hepatitis B, and the CDC 2012 case definition for probable case of chronic hepatitis B have low sensitivity. Case definitions which rely on laboratory confirmation only have maximal sensitivity. EC case definitions showed maximal sensitivity and specificity for hepatitis C confirmed cases. The CDC case definition for chronic hepatitis C showed low sensitivity (36.8%) and low negative predictive value (65.6%) for probable cases and maximal sensitivity and specificity for confirmed cases. Hepatitis C case definitions requiring presence of clinical criteria have low sensitivity and high specificity, resulting from presence of infection and absence of any clinical manifestation, but have high positive and negative predictive values. Conclusion: Syndromic case definitions show low sensitivity and are of limited use. They highlight the importance of laboratory diagnostics (offering maximal sensitivity and specificity, and high positive and negative predictive values), as well as the need for universal case definitions, for confirmed cases only. (C) 2019 The Authors. Published by Elsevier Limited on behalf of King Saud Bin Abdulaziz University for Health Sciences.

The European Centre for Disease Prevention and Control reported that there were 2896 acute hepatitis B cases in 24 EU/EEA countries in 2013.1 The incidence ranged from 0.1 cases per 100,000 in France and Portugal to 4.3 per 100,000 in Latvia, with a male-to-female ratio of 2.2:1 in EU/EEA countries, and transmission among men who have sex with men (MSM) reported in 9.4% of all cases of acute hepatitis B.1 Some authors consider hepatitis B virus (HBV) infection to be endemic in the MSM population with the incidence 20 times higher in MSM than in the general population worldwide.2 However, data on HBV prevalence among MSM are available for only four EU/EEA countries.3 Six to ten percent of MSM infected with HBV worldwide are co-infected with HIV.4 In

Work-related injuries occurring during informal work often go unreported, yet lead to significant mortality and contribute substantially to disease burden due to injury-related disability. In Serbia, injury is a leading cause of death, with work-related injuries comprising a significant proportion. This study explored the frequency of and risk factors for these injuries in a rural Serbian community. During the 12-month study period, physicians from a municipal Primary Care Centre reported all presenting injuries using a specific injury report form. One in four injuries reported occurred during informal work practices, accounting for 71% of all reported work-related injuries. These occurred within the household in 85% of cases, and were more severe in males (79%). Regarding work-related injuries, informal workers were significantly older than formally employed workers, regardless of sex. Public policy should address safety improvements for informal workers, via provision of relevant training and protective equipment.

Seasonal influenza vaccination is one of the most important tools of prevention. Countries currently use many different methodologies to measure national influenza vaccine coverage in populations at higher risk. The study uses two main data sources: The European Health Interview Survey (EHIS) (collected by Eurostat) and OECD statistics, and compares both results. Findings showed that the EHIS survey results observed in this study are mainly lower than OECD data. This can mean that international sources provide overestimated data of coverage compared to outcomes from population surveys.

AIM:To assess and compare general practitioners' (GPs') views of diagnosing and treating depression in five southeastern European countries. METHODS:A cross-sectional study was conducted in Albania, Bulgaria, Moldova, Romania, and Serbia. The sample included 467 GPs who completed a hard-copy self-administered questionnaire, consisting of self-assessment questions related to diagnosing and treating depression. RESULTS:The most common barriers to managing depression in general practice reported by GPs were: patients' unwillingness to discuss depressive symptoms (92.3%); appointment time too short to take an adequate history (91.9%), barriers for prescribing appropriate treatment (90.6%); and patients' reluctance to be referred to a psychiatrist (89.1%). Most GPs (78.4%) agreed that recognizing depression was their responsibility, 71.7% were confident in diagnosing depression, but less than one-third (29.6%) considered that they should treat it. CONCLUSIONS:Improvements to the organization of mental healthcare in all five countries should consider better training for GPs in depression diagnosis and treatment; the availability of mental healthcare specialists at primary care level, with ensured equal and easy access for all patients; and the removal of potential legal barriers for diagnosis and treatment of depression.

Background Vulnerable individuals with tuberculosis (TB) struggle to access and stay on treatment. While patient-related and social barriers to TB treatment adherence are well documented, less is known about how the organisation and delivery of TB care influences adherence behaviour. Aim To examine the influence of TB service organisation and culture on patients’ experience of starting and staying on treatment in Riga, Latvia. Methods An intervention package to support adherence to TB treatment amongst vulnerable patients in Riga, Latvia was piloted between August 2016 and March 2017. Qualitative observations (5), interviews with staff (20) and with TB patients (10) were conducted mid-way and at the end of the intervention to understand perceptions, processes, and experiences of TB care. Results The organisation of TB services is strongly influenced by a divide between medical and social aspects of TB care. Communication and care practices are geared towards addressing individual risk factors for non-adherence rather than the structural vulnerabilities that patients experience in accessing care. Support for vulnerable patients is limited because of standardised programmatic approaches, resource constraints and restricted job descriptions for non-medical staff. Conclusion Providing support for vulnerable patients is challenged in this setting by the strict division between medical and social aspects of TB care, and the organisational focus on patient-related rather than systems-related barriers to access and adherence. Potential systems interventions include the introduction of multi-disciplinary approaches and teams in TB care, strengthening patient literacy at the point of treatment initiation, as well as stronger linkages with social care organisations.

The European Centre for Disease Prevention and Control reported that there were 2896 acute hepatitis B cases in 24 EU/EEA countries in 2013.1 The incidence ranged from 0.1 cases per 100,000 in France and Portugal to 4.3 per 100,000 in Latvia, with a male-to-female ratio of 2.2:1 in EU/EEA countries, and transmission among men who have sex with men (MSM) reported in 9.4% of all cases of acute hepatitis B.1 Some authors consider hepatitis B virus (HBV) infection to be endemic in the MSM population with the incidence 20 times higher in MSM than in the general population worldwide.2 However, data on HBV prevalence among MSM are available for only four EU/EEA countries.3 Six to ten percent of MSM infected with HBV worldwide are co-infected with HIV.4In

SUMMARY Objectives To assess the awareness and attitudes related to blood transfusion safety among blood donors from the Autonomous Province ( AP ) Vojvodina, Republic of Serbia. Background Blood donors are at the initial point of safe blood transfusion systems. The active participation of blood donors in the selection process contributes to increasing the safety of blood transfusions and reduces potential risks for the recipients. Materials and Methods This cross‐sectional survey included 1191 blood donors from AP Vojvodina. The awareness and attitudes regarding safe blood supply were measured as 5‐point scales of agreement/disagreement with statements on a Likert scale. The data were analysed using non‐parametric methods by frequency modalities. Results Male blood donors, the youngest age group (18–20 years), those who donate blood for the first time and those with a lower educational level showed the lowest awareness of, and the most negative attitudes about, blood safety. Conclusions The study found that there is a small but, for the safety of transfusion, significant number of blood donors who do not have a positive attitude or awareness of their own impact on safe transfusion therapy and who are not discovered during standard selection procedures.

Aim: The Public Health Reform II project was implemented in Bosnia and Herzegovina from December 2011 to December 2013 and was funded by the European Union Aid schema. The principal aim of the project was to strengthen public health services in the country through improved control of public health threats. Workshops for primary care physicians were provided to improve the situation and increase communicable diseases notification rates in eight selected primary care centres. They were followed with visits from the project’s implementing team to verify the effects of trainings. Methods: The quality of notifications from physicians in Tuzla region was compared before and after the workshop. The timeliness was used as an indicator of quality. Medians of timeliness before and after the training were compared by use of Wilcoxon test, whereas the averages of timeliness were compared by use of the t-test. Results: There were 980 reported cases, 80% before the training and 20% after the training. A lower median of timeliness for all the reported cases after the training was statistically significant compared to the median value before the training. A similar picture was revealed for specific diseases i.e. tuberculosis and enteritis, not so for scarlet fever and scabies. Conclusion: The significant reduction in time response between the first symptoms and disease diagnosis indicates the positive impact of the training program in Tuzla. Hence, primary care physicians provided better quality of reported data after the training course.

BACKGROUND:The intermittent preventive treatment (IPTp) policy of Malawi (2002) stipulates that IPTp is administered during antenatal care as a direct observation therapy (DOT). The policy further recommends that IPT should be administered monthly after 16 weeks of pregnancy until delivery. This study assessed both the demand and supply factors contributing to higher dropout of IPT after the first dose. Optimal number of doses was pegged at a minimum of three in accordance with WHO recommendation.MATERIALS AND METHODS:Data were analysed from the Malawi multiple indicator cluster survey (2015) and the service provision assessment (2014) of 6637 women (aged 15- 49 yrs), 763 facilities and 2105 health workers. The sample was made up of pregnant women, health facilities and workers involved in routine antenatal services across all regions of Malawi. A composite indicator was constructed to report integration of IPTp with ANC services and administration of IPTp-SP as DOT. Multivariate and logistic regression were conducted to determine associations.RESULTS:Regression analysis found that: 1. Age of women (women 35-49 yrs, AOR 1.98; 95% CI 1.42 - 2.13, number of children as well as the number of ANC visits were associated with optimal uptake of IPTp. 2. Administering IPT as DOT was higher in facilities in rural areas (AOR 1.86; 95% CI 1.54 - 1.92) than in urban areas. 3. Administration of IPTp as DOT was relatively lower in across all facilities with highest being facilities managed by CHAM (72.8%, AOR 1.40; 95% CI 1.22 - 1.54).CONCLUSION:Health system bottlenecks were found to present the main cause of low coverage with optimal doses of IPTp. Incorporating these results into strategic policy IPTp formulation could help improve coverage to desired levels. This study could serve as plausible evidence for government and donors when planning malaria in pregnancy interventions, especially in remote parts of Malawi.

BACKGROUND:Despite a non-decreasing HIV epidemic, international donors are soon expected to withdraw funding from Kazakhstan. Here we analyze how allocative, implementation, and technical efficiencies could strengthen the national HIV response under assumptions of future budget levels. METHODOLOGY:We used the Optima model to project future scenarios of the HIV epidemic in Kazakhstan that varied in future antiretroviral treatment unit costs and management expenditure-two areas identified for potential cost-reductions. We determined optimal allocations across HIV programs to satisfy either national targets or ambitious targets. For each scenario, we considered two cases of future HIV financing: the 2014 national budget maintained into the future and the 2014 budget without current international investment. FINDINGS:Kazakhstan can achieve its national HIV targets with the current budget by (1) optimally re-allocating resources across programs and (2) either securing a 35% [30%-39%] reduction in antiretroviral treatment drug costs or reducing management costs by 44% [36%-58%] of 2014 levels. Alternatively, a combination of antiretroviral treatment and management cost-reductions could be sufficient. Furthermore, Kazakhstan can achieve ambitious targets of halving new infections and AIDS-related deaths by 2020 compared to 2014 levels by attaining a 67% reduction in antiretroviral treatment costs, a 19% [14%-27%] reduction in management costs, and allocating resources optimally. SIGNIFICANCE:With Kazakhstan facing impending donor withdrawal, it is important for the HIV response to achieve more with available resources. This analysis can help to guide HIV response planners in directing available funding to achieve the greatest yield from investments. The key changes recommended were considered realistic by Kazakhstan country representatives.

In 1969, the World Health Organization (WHO) gave the following definition of the drug: “Drugs are any substance that, inserted into the body, can modify one or more functions.” The main goal of our research was to self-assess the level of discrimination by injecting drug users by medical personnel. A cross-section study was conducted, which included respondents using psychoactive substances (PAS) injecting from the Novi Sad area involved in the preventive program of the NGO “Entuzijazam mladih protiv narkomanije-Prevent”. Respondents completed a questionnaire of 27 questions, 21 questions of closed type, and 5 open types.The research involved 100 respondents (16 women and 64 men). The respondents most frequently used marijuana (100% of respondents), heroin 97%, cocaine in 31% compared to the total number of respondents. 40% of respondents experienced discrimination by a general practitioner simply because they use PAS, 28.6% of respondents experience a discrimination by dentists; 22.6% of respondents have an experience of discrimination by doctors of other specialties only because they use PAS. 56% of respondents in our sample know that the Law on the Prohibition of Discrimination has been passed.People who use PAS by injecting a young person come into contact with the PAS and begin to consume it, at the age of 16. PAS users stated that they were discriminated against by general practitioners, dentists and doctors of other specialties.